Pharmacy Member Outreach Rep

About the Organization

Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two. Founded in 1993 as a health maintenance organization (HMO), Prominence Health was acquired by a subsidiary of Universal Health Services, Inc. (UHS) in 2014. The organization serves members, physicians, and health systems across Medicare, Medicare Advantage, Accountable Care Organizations, and commercial payer partnerships. Prominence Health is committed to transforming healthcare delivery by improving health outcomes while controlling costs and enhancing the patient experience.

About the Role

The Member Outreach Pharmacy Representative serves as the liaison between Prominence Health Plan, its members, and contracted providers. This role focuses on contacting members by phone to inform and educate them on health insurance offerings, products, or services, as well as responding to inquiries and assisting with quality improvement. The representative will also resolve drug-related care gaps during telephonic outreaches, facilitate the development of the outreach program, and serve as the primary contact for education, technical assistance, and problem-solving. Additionally, this role identifies quality insufficiencies and consults with leadership on quality improvement initiatives and outcomes.

Responsibilities

• Conduct outbound calls to Prominence Health Plan members to educate them on health insurance offerings, products, or services.
• Respond to member inquiries and assist with quality improvement initiatives.
• Resolve drug-related care gaps during telephonic member outreaches.
• Facilitate the development of the outreach program and serve as the primary contact for education, technical assistance, and problem-solving.
• Identify quality insufficiencies and consult with department and company leaders on quality improvement initiatives and outcomes.
• Collect and track performance metrics, managing the team to meet performance expectations.

Requirements

• High School diploma or equivalent required.
• Current and valid state licensure as a pharmacy technician is preferred.
• Current PTCB license preferred.
• 3+ years' experience in making outbound calls to members and/or patients preferred.
• 3+ years' experience in retail/community pharmacy preferred.
• Exceptional customer service skills, with a focus on serving patient needs over the phone.
• Understanding of health plan departments and functional areas for problem resolution.
• Knowledge of current state laws pertaining to pharmacy dispensing.
• Strong analytical skills and attention to detail.
• Proficiency in Microsoft Office (Excel, Adobe, Word, Outlook, etc.).
• Ability to effectively communicate in English, both verbally and in writing. Written and oral fluency in Spanish is preferred.
• Sound drug knowledge to assist with patient questions over the phone effectively.
• Knowledge of medical terminology.

Skills

• Positive attitude and ability to work in both individual and team settings.
• Strong problem-solving skills and ability to execute projects in a fluid, fast-paced environment.
• Self-starter, resourceful, and comfortable with technology and multiple software programs.
• Strong communication and relationship-building skills.
• High level of energy and attention to detail.

Benefits

• Loan Forgiveness Program.
• Challenging and rewarding work environment.
• Competitive compensation and generous paid time off.
• Excellent medical, dental, vision, and prescription drug plans.
• 401(K) with company match and discounted stock plan.
• SoFi Student Loan Refinancing Program.
• Career development opportunities within UHS and its 300+ subsidiaries.

More information is available on the Benefits Guest Website.